Early epidural blood patch in spontaneous intracranial hypotension.

Thirty patients with a typical orthostatic headache were treated by early lumbar epidural blood patch (EBP) without previously performing lumbar puncture or identifying a CSF leak and with or without typical MRI changes. A complete cure was obtained in 77% of patients after one (57%) or two (20%) EBPs. Spontaneous intracranial hypotension with typical orthostatic headache can be diagnosed without lumbar puncture and can be cured by early EBP in a majority of patients.

[Transcranial Doppler imaging: state of the art]. / Echo-Doppler transcrânien: Mise au point.

Initially introduced in the early 1980's, transcranial Doppler followed by transcranial Doppler sonography were used in neurosurgical units for management and follow-up of intracranial vasospasm in patients with subarachnoid hemorrhage. This imaging technique, more sensitive and less invasive than catheter angiography, also proved to be of value for diagnosis of intracranial atherosclerosis, management of patients with head trauma, and evaluation of collateral flow through the circle of Willis. Doppler US would also allow prediction of the risk of symptomatic embolic events through monitoring of HITS. Evaluation of the middle cerebral arteries during carotid occlusion testing is useful for evaluating the need for particular revascularization techniques. Finally, Doppler imaging is useful to assess patients with possible brain death. A recent advance in Doppler imaging is the ability to provide a three-dimensional projection (3D Doppler) of the intracranial arteries enabling improved detection and evaluation of stenoses involving the circle of Willis and improved characterization of intracranial aneurysms. These new applications benefit from the use of US contrast agents and harmonic US imaging.

Pilocytic astrocytoma: unusual feature.

Juvenile pilocytic astrocytoma is a well-defined brain tumor. It most often occurs in children and young adults. It is located in the posterior fossa and has typical imaging features, associating cystic and strongly contrast enhancing mural nodule. After complete surgical removal, its prognosis is excellent. Adult cases are seldom observed. They develop almost exclusively within the cerebral hemispheres and share the same imaging and prognostic characteristics as the pediatric forms. We describe the case of a 42-years-old man presenting with a huge heterogenous posterior fossa lesion. Histopathological analysis of the lesion after surgical resection diagnosed a juvenile pilocytic astrocytoma. These peculiar location and imaging features in an adult patient may be misdiagnosed for infectious lesions and must be recognized.

[Atypical cerebral lymphoma with ocular onset: report of a case]. / Lymphome cérébral atypique à révélation oculaire: à propos d'un cas.

A 72 year-old woman is hospitalized and explored in the neurological department because of dementia discovered after a vitrectomy performed to treat a relapsing chronic uveitis. MRI examination shows atypical hyperintense white matter lesions on T2 weighted images related to Lyme disease. Worsening of clinical status, despite appropriate medical treatment and apparition of enhanced nodules MR images rules out the diagnosis of lyme disease and is attributed to brain metastases. The search for primitive tumor is not contributive and a brain biopsy is performed. It discloses a B cells non-hodgkin lymphoma. This case report stresses two points: first, a lymphoma must be one of the diagnosis to evocate if imaging shows an enhancing nodule, or extensive hypersignal of the white matter, second: it emphasizes the value of vitreous analysis searching for lymphoma during chronic uveitis associated to neurological symptoms.